The Veress Needle was originally designed for insertion into the chest to collapse a lung in treatment of tuberculosis. Later, when laparoscopy was first introduced to allow surgeons to look into the peritoneal cavity, the needle found new usage in filling the abdominal cavity with carbon dioxide. The Veress Needle comprises an outer cannula which has a needle point for easy penetration of the skin and underlying structures in the abdominal wall. The outer cannula expands into a relatively long needle hub which is used to house a spring mechanism for retraction of an inner cannula. This inner cannula includes a hollow tube having an enclosed end which is rounded to help avoid injury of the intra-abdominal structures. There is a side hole spaced above the distal end of the inner cannula to allow flow of carbon dioxide gas. Thus, when the needle point is pushed through the skin and other structures of the abdominal wall, the inner cannula is fully retracted within the inner cannula to allow easy penetration all the way through the abdominal wall. After the abdominal wall is penetrated, the inner, rounded tip, snaps forwardly into the space of the abdominal cavity and pushes underlying movable structures out of the way, such as large or small bowel or intestine, omentum or liver. The gas is then delivered to the abdominal cavity via a gas delivery system which is connected to the upper hub or valve section of the Veress Needle by a long plastic delivery tube. This gas creates a space or work area within the abdomen whereby good visualization is provided through a separate laparoscope. Any definitive surgical procedures, such as tubal ligations must generally be done through a separate opening, unless an operative laparoscope is utilized.
Although the Veress Needle has been a very useful instrument for about fifty years, it has certain drawbacks. It is a complex design and therefore expensive to manufacture. Because of its construction and small parts, the parts can be lost during cleaning and it is virtually impossible to clean the side hole adjacent the blunt tip of the inner cannula, resulting in small pieces of tissue and tissue fluid being transferred from one patient to the next. Also, after repeated use, the point becomes dull. Furthermore, the needle can be dislodged if left in place during an entire operative procedure and must be reinserted. Also, because of the rigid construction, the sharp end may be driven into the abdomen and cause damage to intra-abdominal contents such as the bowel, liver or major blood vessels if accidentally bumped by the surgeon. Furthermore, the Veress Needle can only be used for gas delivery and is not usable for a port hole for introduction of a laparoscope, operating instruments, cautery devices, laser fiber or other devices. If these devices are used they must be introduced through an additional trochar which creates an additional incision in the patient.
The most pertinent art is my U.S. Pat. No. 4,869,717 for "Gas Insufflation Needle With Instrument Port". A disposable trochar is provided which has a removable rod and needle portion within an outer sheath. The rod has a blunt end and is retractable during insertion so that the needle edge cuts through the abdominal wall. Once passing through the wall the rod extends so as to protect the bowel from the sharp needle. A gas port is provided for introducing gas through the rod and out a side passageway near the blunt end. After the abdomen is extended, the rod and needle can be removed as a unit from the sheath and thrown away and a suitable instrument introduced through an instrument port having a separate diaphragm. The gas can continue to be introduced around the instrument and into the abdomen while the instrument is in place. After the required medical procedures are completed, the instrument is removed. Then the sheath and associated parts are removed and thrown away. Other instruments have been devised which comprise concentric cannulas for various procedures. Among these instruments are the following:
U.S. Pat. No. 1,527,291 to Zorraquin shows a surgical needle which has a spring urged blunt rod within it to permit exploration of internal body cavities without perforating the wall of the cavity being explored.
U.S. Pat. No. 2,630,803 to Baren shows a pneumothoracic needle with spring-loaded inner blunt needle and an outer sharp cannula. The inner blunt needle is hollow and is removable without extracting the cannula from the chest wall.
U.S. Pat. No. 3,840,008 to Noiles discloses a hypodermic needle for safely injecting fluid into nerve and vessel crowded areas of a patient. The needle has a pointed hollow piercing member slidably mounted about a fluid delivery tube. The delivery tube has a blunt nose with at least one fluid opening near its blunt end, the other end being connected to a conventional syringe. The hollow piercing member is connected to the delivery tube by a finger-operated collapsible bar. The bar is provided with a centrally located groove to facilitate collapse at the moment the operator removes the force of his finger. The blunt nose delivery tube is then free to penetrate the tissue of the patient without endangering nerve or vessel.
U.S. Pat. No. 3,982,533 to Wiest discloses a device for introducing limited quantities of carbon dioxide into the human body for operational purposes, particularly laparoscopy. It includes a control device for delivering the carbon dioxide, a connecting nipple on the control device for connecting a flexible tubing to a Veress Needle introduceable into the body and a pressure gage for indicating the pressure present in the body cavity. A second connection nipple is provided on the control device and connected by a nipple to the pressure gage. The second connection nipple is connected by a further flexible tubing either to a dual Veress Needle or to a second single Veress Needle, so that the pressure gage is directly connected with the body cavity rather than through the operative Veress Needle.
U.S. Pat. No. 4,096,860 to McLaughlin discloses an encatheter incorporating a plastic insertion conduit placed into a blood vessel with a needle. The structure includes an elastomeric sealing flapper or one-way valve that allows insertion of a syringe needle.
U.S. Pat. No. 4,424,833 to Spector et al. describes a molded self-sealing gasket assembly through which, for instance, a catheter may be inserted and removed.
U.S. Pat. No. 4,535,773 to Yoon shows a safety puncturing instrument and method using a shielding mechanism that is biased to protrude from the distal end of the instrument to shield its sharp, penetrating point after the point has penetrated.
U.S. Pat. No. 4,769,018 to Wilson discloses a surgical cannula assembly for receiving and guiding a surgical instrument which has an instrument portion insertable through the cannula assembly and includes two selectively interconnectable and separate cannula sub-assemblies.
U.S. Pat. No. 4,808,168 to Waring discloses a single-use Veress-type pneumoneedle that has a flanged handle and a fixed valve sub-assembly that permits the pneumoneedle to be gripped like a syringe when it is being inserted. The stylet body is either a solid rod or a hollow tube. Insufflating gas is carried into the abdominal cavity through the lumen of the needle when the stylet is a solid rod or through the stylet lumen when the stylet is a hollow tube.
French Patent No. 2,308,346 to Storz discloses a probe for insertion of surgical instruments or insufflation tubes in the cavities of a body. It has a probe sleeve in which the instrument or tube is guided axially and which is enclosed by a tubular casing so as to form an air passage around it with air entry ports at the end.